Advanced HIV Presenting With Pancytopenia and HLH-Like Hyperinflammation Secondary to Disseminated Talaromycosis: A Case Report.

Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that may complicate advanced HIV infection, most commonly triggered by opportunistic infections. We report a man with advanced HIV who presented with prolonged fever and pancytopenia without an identifiable source despite extensive investigation. Bone marrow examination demonstrated haemophagocytosis, while blood mycobacterial culture yielded Penicillium marneffei, now classified as Talaromyces marneffei. Together with prolonged fever, pancytopenia, marked hyperferritinaemia and a retrospective HScore of 189, these findings supported disseminated talaromycosis with an HLH-like hyperinflammatory syndrome; complete HLH-2004 testing was not available. The patient demonstrated rapid clinical and haematological recovery following antifungal therapy with amphotericin B, without the need for HLH-directed immunosuppressive treatment. Antiretroviral therapy was subsequently initiated, followed by successful treatment of chronic hepatitis C infection. This case highlights the importance of early consideration of fungal infections and HLH-like syndromes in advanced HIV, as well as the diagnostic value of bone marrow examination in identifying treatable causes of prolonged febrile illness.